Chonnam Med J.  2011 Dec;47(3):165-169. 10.4068/cmj.2011.47.3.165.

Complications Following Outside-in and Inside-out Transobturator-Tape Procedures with Concomitant Gynecologic Operations

• Cho MK
• Kim CH
• Kang WD
• Kim JW
• Kim SM
• Kim YH

• KMID: 2172226
• DOI: http://doi.org/10.4068/cmj.2011.47.3.165

Abstract

This study was undertaken to compare the complications of outside-in transobturator tape procedures (TOT) and inside-out transobturator tape procedures (TVT-O) with concomitant gynecologic surgery for the treatment of female stress urinary incontinence (SUI). A retrospective review of 206 consecutive patients who underwent either TOT or TVT-O with concomitant gynecologic operations between March 2008 and February 2011 was conducted. The incidence of perioperative complications was compared. For statistical analysis, chi-squared tests were used. There were no reports of intraoperative complications such as vaginal injury or bladder perforation. Postoperative complications were noted in 23 procedures (11.2%). These included 6 cases of urinary retention (2.9%), 2 cases of vulva hematoma (1.0%), 7 cases of urinary tract infection (3.4%), 4 cases of de novo urgency (2.9%), and 4 cases of vaginal erosion (2.9%). There were no significant differences in complication rates between the two groups. Our results suggest that inside-out and outside-in procedures are simple and safe techniques that may have a low rate of complications when used with a concomitant gynecologic operation.

Keyword

Complications; Urinary stress incontinence; Gynecologic surgical procedures

MeSH Terms

Female
Gynecologic Surgical Procedures
Hematoma
Humans
Incidence
Intraoperative Complications
Postoperative Complications
Retrospective Studies
Suburethral Slings
Urinary Bladder
Urinary Incontinence
Urinary Incontinence, Stress
Urinary Retention
Urinary Tract Infections
Vulva

Reference

1. Bemelmans BL, Chapple CR. Are slings now the gold standard treatment for the management of female urinary stress incontinence and if so which technique? Curr Opin Urol. 2003. 13:301–307.

2. Petros PE, Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol Suppl. 1993. 153:1–93.

3. Doo CK, Hong B, Chung BJ, Kim JY, Jung HC, Lee KS, et al. Five-year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence. Eur Urol. 2006. 50:333–338.

4. Nilsson CG, Falconer C, Rezapour M. Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol. 2004. 104:1259–1262.

5. Holmgren C, Nilsson S, Lanner L, Hellberg D. Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence. Obstet Gynecol. 2005. 106:38–43.

6. Meschia M, Pifarotti P, Bernasconi F, Guercio E, Maffiolini M, Magatti F, et al. Tension-Free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2001. 12:Suppl 2. S24–S27.

7. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001. 11:1306–1313.

8. deTayrac R, Deffieux X, Droupy S, Chauveaud-Lambling A, Calvanèse-Benamour L, Fernandez H. A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol. 2004. 190:602–608.

9. Wang AC, Lin YH, Tseng LH, Chih SY, Lee CJ. Prospective randomized comparison of transobturator suburethral sling (Monarc) vs suprapubic arc (Sparc) sling procedures for female urodynamic stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2006. 17:439–443.

10. de Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol. 2003. 44:724–730.

11. Debodinance P. Trans-obturator urethral sling for the surgical correction of female stress urinary incontinence: outside-in (Monarc) versus inside-out (TVT-O). Are the two ways reassuring? Eur J Obstet Gynecol Reprod Biol. 2007. 133:232–238.

12. But I, Faganelj M. Complications and short-term results of two different transobturator techniques for surgical treatment of women with urinary incontinence: a randomized study. Int Urogynecol J Pelvic Floor Dysfunct. 2008. 19:857–861.

13. Lee KS, Choo MS, Lee YS, Han JY, Kim JY, Jung BJ, et al. Prospective comparison of the 'inside-out' and 'outside-in' transobturator-tape procedures for the treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008. 19:577–582.

14. Smith PP, Appell RA. Pelvic organ prolapse and the lower urinary tract: the relationship of vaginal prolapse to stress urinary incontinence. Curr Urol Rep. 2005. 6:340–347.

15. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol. 2002. 187:116–126.

16. Al-Singary W, Shergill IS, Allen SE, John JA, Arya M, Patel HR. Trans-obturator tape for incontinence: a 3-year follow-up. Urol Int. 2007. 78:198–201.

17. Delmas V, Hermieu JF, Dompeyre P, Messas A, Dumonceau O, Ravery V, et al. The transobturator sling tape uratape: anatomical dangers. Eur Urol Suppl. 2003. 2:197.

18. Laurikainen EH, Valpas A, Kiilholma P, Takala T, Kivela A, Aukee P, et al. A prospective randomized trial comparing TVT and TVT-O procedures for treatment of SUI: immediate outcome and complications. Int Urogynecol J Pelvic Floor Dysfunct. 2006. 17:Suppl 2. S104.

19. Mansoor A, Vedrine N, Darcq C. Surgery of female urinary incontinence using trans-obturator tape (TOT): a prospective randomized comparative study with TVT. Neurourol Urodyn. 2003. 22:488–489.

20. David-Montefiore E, Frobert JL, Grisard-Anaf M, Lienhart J, Bonnet K, Poncelet C, et al. Peri-operative complications and pain after the suburethral sling procedure for urinary stress incontinence: a French prospective randomised multicentre study comparing the retropubic and transobturator routes. Eur Urol. 2006. 49:133–138.

21. Bonnet P, Waltregny D, Reul O, de Leval J. Transobturator vaginal tape inside out for the surgical treatment of female stress urinary incontinence: anatomical considerations. J Urol. 2005. 173:1223–1228.

22. Hermieu JF, Messas A, Delmas V, Ravery V, Dumonceau O, Boccon-Gibod L. Bladder injury after TVT transobturator. Prog Urol. 2003. 13:115–117.

23. Minaglia S, Ozel B, Klutke C, Ballard C, Klutke J. Bladder injury during transobturator sling. Urology. 2004. 64:376–377.

24. Abdel-Fattah M, Sivanesan K, Ramsay I, Pringle S, Bjornsson S. How common are tape erosions? A comparison of two versions of the transobturator tension-free vaginal tape procedure. BJU Int. 2006. 98:594–598.

25. Houwert RM, Renes-Zijl C, Vos MC, Vervest HA. TVT-O versus Monarc after a 2-4-year follow-up: a prospective comparative study. Int Urogynecol J Pelvic Floor Dysfunct. 2009. 20:1327–1333.

26. Latthe PM, Foon R, Toozs-Hobson P. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG. 2007. 114:522–531.

27. Achtari C, McKenzie BJ, Hiscock R, Rosamilia A, Schierlitz L, Briggs CA, et al. Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings. Int Urogynecol J Pelvic Floor Dysfunct. 2006. 17:330–334.